PCTs gain powers to force services out to community

Commissioners will be able to force hospitals to provide services in the community or make their staff available to other providers.

The new competition rules could eventually lead to acute trusts having to share their facilities, equipment and premises if they try to block the transfer of services out of hospitals.

Individual providers may have the ability to restrict choice or competition by refusing to recognise or accept services or refusing to supply essential services

The “third party access” principles, published by the Department of Health last week, effectively remove acute trusts’ ability to block the movement of services into the community.

According to the DH they establish “requirements for individual providers to accept services or provide services in cases where refusal would restrict choice or competition against patients and taxpayers’ interests”.

“For example, an established provider with a powerful position in a local market might be able to prevent commissioners from transforming services and introducing new providers by refusing to supply essential services such as hospital consultants to them.”

Cooperation and competition panel director Andrew Taylor, speaking last week at a Nuffield Trust conference, said: “I can envisage this being extended to access to equipment, facilities, premises, all sorts of things.”

He told HSJ the rule, due to come into force from October, was likely to be used in cases where providers monopolised part of a service that primary care trusts wanted to move to the community, for example critical care nursing.

The DH guidance states it is “premature” to introduce rules governing access to facilities or infrastructure at this stage.

This will be considered by the cooperation and competition panel, the DH and Monitor, which will also look at which services will be covered by the rules and how trusts will be compensated, with further guidance expected in October.

PCT Network director David Stout said the rule would make it easier to redesign services.

But he said it did not allow commissioners to make radical changes such as re-tendering accident and emergency services. He said: “That would add strength to the commissioning role. It would be more significant potentially for driving change.”